Nonsuicidal self-injury (NSSI) is prevalent among young adults, and is associated with increased suicide risk. The self-punishment hypothesis theorizes that individuals who are highly self-critical may engage in NSSI due to finding the experience of pain as ego-syntonic. Although evidence links self-critical views to NSSI, minimal research has examined how these views are influenced by more proximal social stressors, such as peer criticism, to trigger NSSI urges. The current study addresses the following questions: (1) Will the effects of recalled peer criticism (vs. praise and a neutral interaction) on pain endurance (a proxy measure for NSSI urges) and self-reported NSSI urges be moderated by group status (i.e., whether or not an individual has a history of NSSI)? We hypothesized that group status would moderate the effects of recalled peer criticism on pain endurance and NSSI urges, such that the relationships between these constructs would be stronger among the NSSI group vs. the no NSSI group; (2) If these interaction effects are present, will they be mediated by self-critical views? We hypothesized that the interaction between group status and peer criticism on pain endurance and NSSI urges would decrease in magnitude after accounting for self-critical views. Participants were 137 young adult women with either a recent or recurrent history of NSSI (n = 79) or no NSSI history (n = 58). Idiographic scripts of a recalled peer interaction involving critical, praising, or neutral feedback were used as the experimental manipulation, and measures of pain endurance (via a pressure algometer) and self-reported NSSI urges were administered at baseline and post-manipulation. The NSSI group demonstrated marginally higher pain endurance and stronger self-critical views than the control group. The overall effects of recalled peer criticism were not moderated by group status in predicting pain endurance or NSSI urges. Exploratory pairwise comparisons revealed that those in the NSSI group who received criticism (vs. the other conditions) demonstrated a significant increase in NSSI urges. Findings highlight peer criticism as one context in which risk for NSSI urges may be elevated among those with a history of NSSI, and underscore self-critical views as an important intervention target.

En experimentell vinjettstudie genomfördes för att undersöka hur graden av em-pati för personer med ett självskadebeteende varierar beroende på bakomliggande orsak samt grad av kännedom om ämnet. I studien deltog 121 respondenter som fick besvara en av tre vinjetter: (a) självskadebeteende utan angiven orsak, (b) Självskadebeteende med orsak borderline personlighetsstörning eller (c) Självska-debeteende med orsak övergrepp. Studien visade att ett samband mellan empati och självskadebeteende utan orsak samt mellan empati och självskadebeteende med orsak borderline personlighetsstörning. Inget samband påvisades mellan em-pati och självskadebeteende med orsak övergrepp. Vidare framkom inga signifi-kanta skillnader mellan grupperna i empatigrad, vilket kan ha att göra med att självskadebeteende som enskild variabel var tillräcklig för att generera ett visst mått av empati. Empatimedelvärdet för någon som skär sig låg strax under media-nen på Batsons empatiskala vilket tyder på att medmänniskor känner en genom-snittlig grad av empati för någon som skär sig.

Nonsuicidal self-injury (NSSI), the deliberate self-destruction of one’s own body tissue engaged in without associated suicidal intent, is a prevalent behavior among adolescents and young adults. The current study examined whether one aspect of cognitive control, inhibitory control in response to negative emotional stimuli, is associated with repetitive engagement in NSSI. It further sought to examine whether sleep deficiency/irregularity, stress, and reward sensitivity moderate this relationship. A multi-method approach (self-report, behavioral measures, actigraphy) was employed to sensitively probe these relationships among 114 late adolescents with and without a history of repetitive NSSI. Findings suggested no relationship between inhibitory control in response to negative emotional stimuli and NSSI, as measured by a behavioral measure, but a significant positive relationship as measured by self-report. Stress and sleep irregularity, but not sleep deficiency or reward sensitivity, were associated with NSSI group status. Interaction analyses suggested that sleep irregularity and stress moderated the relationship between inhibitory control in response to negative emotional stimuli and NSSI. Results are discussed in terms of conceptual and clinical implications. Findings highlight the necessity of examining the temporal dynamics between the study’s constructs and NSSI by employing an ecologically valid approach. / Psychology

Nonsuicidal self-injury (NSSI) is the deliberate destruction of one's own body tissue (e.g., cutting, skin picking, biting, hitting) without conscious suicidal intent. Cognitive and affective difficulties may contribute to the development and maintenance of NSSI, such that emotion regulation may mediate the link between cognitive control difficulties and NSSI in youth. This study examined developmental links between cognitive control and emotion regulation on several facets of self-injurious thoughts and behaviors in a large sample of youth, collected via the ABCD Study (N=6447). Although a mediation of emotion regulation on cognitive control and self-injurious thoughts and behaviors was not supported, important direct effects were found between neural correlates of inhibition (at ages 9-10 years) on NSSI at 11-12 years, and behavioral measures of cognitive flexibility (at 10-11 years) and inhibition (at 9-10 years) on suicidality at 11-12 years. Further, links between poorer cognitive control and poorer emotion regulation were found. An exploratory aim of this study was examining the potential moderating role of autistic traits on significant associations. Although greater autistic traits significantly predicted presence of self-injurious thoughts and behaviors, this study did not find a moderation of autistic traits. These results provide developmental risk markers for NSSI and suicidality in youth. / Doctor of Philosophy / Nonsuicidal self-injury (NSSI) is the direct and intentional harm to one's own body (e.g., cutting, skin picking, biting, hitting) without suicidal intent. One's ability to regulate their cognitions and emotions may explain risk and continuation of NSSI and other suicidal thoughts and behaviors. In specific, one's ability to regulate their emotions may explain the relationship between cognitive control and NSSI in youth. This study examined the relationship between cognitive control and emotion regulation on NSSI and suicidality in a large sample of youth, , collected from the ABCD Study (N=6447). Although emotion regulation did not explain the relationship between cognitive control and NSSI or suicidality, results showed that brain activation when trying to inhibit a response at ages 9-10 related to presence of NSSI at ages 11-12. Additionally, behavior related to one's ability to flexibly shift (at ages 10-11) and inhibit responses (at ages 9-10) related to suicidality at ages 11-12. Links between poorer cognitive control and poorer emotion regulation were also found. Recent work has also found that autistic youth have high rates of NSSI and suicidality, thus, the level of autistic traits on these relationships were evaluated. Although greater autistic traits significantly predicted presence of self-injurious thoughts and behaviors, this study did not find that level of autistic traits impacted links between cognitive control, emotion regulation, and NSSI or suicidality. These results provide developmental risk markers for NSSI and suicidality in youth.

Nonsuicidal self-injury (NSSI) is a behavior recently added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a condition for further study. In this dissertation, I present findings from three studies that inform the clinical description of NSSI as well as some of the cognitive and emotional aspects of NSSI. In Study 1, I examined data from a community sample of adult women who met proposed DSM-5 criteria for NSSI or subthreshold NSSI. The findings show that any experience with NSSI is associated with significant impairment. Further, they suggest that greater self-criticism may be a key variable capable of distinguishing between people who engage in more versus less frequent NSSI. In Study 2, I examined the extent to which cognitive deficits in inhibiting emotional information may characterize people who engage in NSSI. Although NSSI participants endorsed greater difficulty with negative thoughts relative to controls, the groups demonstrated no differences on a directed forgetting task. These findings are consistent with previous research on emotional reactivity and impulsivity in NSSI that shows a similar dissociation between self-report and behavioral-based results. In Study 3, I examined how people process NSSI images. Results suggest that people who engage in NSSI view NSSI stimuli as relatively non-aversive. This is in sharp contrast to healthy controls, who consider NSSI images as highly aversive. These finding are consistent with models of NSSI that regard self-injury as providing reinforcement (positive and negative). Overall, the findings from these studies add to the clinical description of NSSI and support its diagnostic validity. Our examination of the clinical characteristics of the NSSI as described in DSM-5 highlights the importance of assessing the presence of any NSSI behavior as well as highly self-critical thoughts. Importantly, we found no evidence of memory deficits in NSSI. Of great clinical concern, however, is the extent to which engaging in NSSI appears to erode the aversive nature of NSSI stimuli. Taken together, our findings support a model in which self-criticism may reduce the initial barriers to engaging in NSSI, with the mood benefits associated with NSSI subsequently serving to maintain it. / Psychology

This study explored the potential for physical activity to be an effective, healthy coping strategy alternative to self-harm behaviors. Regression analyses were performed to assess how physical activity level related to risk factors (i.e., emotional dysregulation, self-esteem, and depression) and self-harm behaviors. The relationship between selfharm and exercise motivations was also examined. Participants were recruited from two high schools (n = 95) and one university (n = 72) in the southeastern region of the United States. Analyses were run using the following measures from a survey packet: adapted Exercise Questionnaire (Helmerhorst, Brage, Warren, Besson, & Ekelund, 2012), Exercise Motivations Inventory—Second Edition (Markland & Ingledew, 1997), Inventory of Statements About Self-Injury (Klonsky & Olino, 2008), Reynolds Adolescent Depression Scale – 2nd Edition (Reynolds, 2002), Eating Disorders Inventory – 3 (Garner, 2004), and Center for Epidemiologic Studies Depression Scale (Miller, Anton, & Townson, 2008). Of the 167 who participated, 41.3% endorsed at least one instance of nonsuicidal self-injury (NSSI). Results indicated that NSSI frequency was significantly negatively associated with physical activity (β = -.22, p < 0.01). An interaction was found between physical activity and depression, such that physical activity moderated the relationship between depression and self-harm. The overall model explained 28.2% of the variance, F(3,145) = 10.02, p < .01. Affiliation and appearancebased exercise motivations significantly associated with decreased (β = -.244, p = .047) and increased (β = .320, p = .001) frequencies of self-harm, respectively. Overall, the findings suggest that physical activity may possess a protective nature against self-harm behaviors, especially in individuals with depressive symptoms.

Nonsuicidal self-injury (NSSI) refers to direct and deliberate damage of one’s bodily tissue without the intent to die. Although NSSI abates over time for most young people, 8-32% of those with a history of NSSI exhibit a severe pattern of engagement characterized by high or increasing NSSI frequency (i.e., number of episodes) and versatility (i.e., number of methods). Unfortunately, despite these markers of NSSI severity conferring risk for psychosocial dysfunction and suicidal behaviour, the mechanisms that explain why NSSI increases in frequency or versatility are poorly understood. Behavioural models of NSSI propose that experiencing desirable emotional and social consequences following NSSI is a key mechanism that increases the intensity/strength of the behaviour. Yet, behavioural models of NSSI do not specify whether experiencing more desirable consequences relative to other people (i.e., between-person) or experiencing more desirable consequences relative to one’s own average (i.e., within-person) more strongly predicts future NSSI severity. To address this gap in theory, the present study investigated the influence of between- and within-person desirable NSSI consequences on the frequency and versatility of NSSI over four lags spaced three months apart. 210 adolescents and adults (93.81% female, Mage = 22.95 [SD = 7.17]) with a history of NSSI were recruited from NSSI communities on social networking websites and completed self-report surveys assessing the desirable consequences, frequency, and versatility of NSSI every three months for one year. At the within-person level, time-lagged hierarchical linear models revealed that experiencing more desirable emotional consequences following NSSI at TimeT, relative to one’s own average, was unrelated to NSSI frequency at TimeT+1, but predicted a rise in NSSI versatility at TimeT+1. Conversely, experiencing more desirable social consequences following NSSI at TimeT, relative to one’s own average, predicted a decrease in NSSI frequency at TimeT+1, but was unrelated to NSSI versatility at TimeT+1. At the between-person level, neither desirable emotional consequences nor desirable social consequences of NSSI predicted NSSI frequency or versatility during the study. While only partially consistent with behavioural models of NSSI, these results suggest that: (1) desirable emotional and social consequences of NSSI exert opposing influences on NSSI severity, (2) within-person increases in desirable emotional consequences of NSSI portend periods of elevated NSSI risk, and (3) empirical tests of behavioural models of NSSI should consider not only how many times but how many ways a person self-injures. By enhancing our understanding of why some individuals persistently self-injure, this study provides a springboard for refining behavioural models of NSSI, advancing longitudinal research on the contingencies that maintain self-injury, and ameliorating intervention efforts that draw on the principle of operant conditioning to reduce NSSI. / Graduate

Nonsuicidal Self-Injury (NSSI), or the deliberate damage of bodily tissue without suicidal intent, is a prevalent issue in young people. Relative to those who have never self-injured, young people with either recent (i.e., past-year) or distal (i.e., lifetime, but not in the past year) histories of NSSI demonstrate difficulties with emotion regulation, the process of modulating emotional responses. Emotion regulation difficulties are a risk factor for other forms of Self-Damaging Behaviours (SDBs), including binge drinking, substance use, and binge eating, which are more prevalent among individuals with a history of NSSI. Prominent theoretical models of NSSI and other SDBs posit that these behaviours may share a common function of altering negative mood states, explaining their frequent co-occurrence. The present study hypothesized that first-year university students with distal, recent, or no history of NSSI a) would differ in their rates of SDB engagement over seven months, and b) would differ in their strength of association between changes in stress and concurrent SDB engagement. Further, the present study hypothesized that emotional dysregulation would moderate the association between stress and SDB engagement. Multilevel modelling with longitudinal data from two cohorts of first-year undergraduates (N=540) revealed that students with either distal or recent NSSI histories were more likely to engage in substance use than their peers who had never self-injured, but did not report a greater frequency of binge eating or binge drinking. Regardless of NSSI history, substance use was unrelated to within-person changes in stress or emotional dysregulation. Higher-than-usual stress was associated with increased frequency of binge eating and binge drinking, but this association was unrelated to NSSI history or emotional dysregulation. Results suggest that elevated risk for substance use may persist even after NSSI has stopped, while other forms of SDBs (i.e., binge drinking and binge eating) were not predicted by NSSI history. Further, results suggest that some SDBs (i.e., binge drinking and binge eating) are enacted more frequently during periods of stress, but that this pattern is not unique to those with a history of NSSI or those who struggle to regulate their emotions. Consistent with person-centred models of NSSI recovery, these results suggest that vulnerability to some SDBs may persist even after NSSI has stopped. Future research should further examine the mechanisms underlying the complex association between NSSI and SDBs. / Graduate

Nonsuicidal self-injury (NSSI; i.e., the deliberate destruction of one’s own bodily tissue without suicidal intent and for reasons not socially sanctioned) is prevalent and associated with clinically serious consequences. There is a need for evidence-based, stand-alone treatments for this behavior as it presents across the full range of psychiatric disorders. Developing time-efficient and cost-effective interventions for NSSI has proven difficult given that the core components of treatment remain largely unknown. The aim of this study was to examine the specific effects on NSSI of mindful emotion awareness training and cognitive reappraisal, two transdiagnostic treatment strategies that directly address the functional processes that often maintain self-injury (i.e., relief or escape from aversive thoughts or feelings). Using a counterbalanced, combined series (multiple baseline and phase change) single-case experimental design, the unique and combined impact of these two four-week interventions was evaluated among diagnostically heterogeneous, self-injuring adults (N = 10; mean age = 21.3, range = 18 to 30 years). Hypotheses were that each intervention would produce clinically meaningful reductions in NSSI; adding the alternative intervention would have additive benefit for those who did not respond to the initial intervention alone; and reductions in NSSI would be maintained over a four-week follow-up phase. Results showed that 8 of 10 participants demonstrated clinically meaningful reductions in NSSI by the follow-up phase; six participants responded to one intervention alone, whereas adding the alternative intervention was associated with additive benefit for two participants. Group-based analyses indicated a statistically significant effect of study phase on NSSI (p < .001), with fewer NSSI urges and acts occurring after the interventions were introduced. The interventions were also associated with moderate to large reductions in anxiety (d = 0.89 – 1.09), depression (d = 0.79 – 1.09), and interference caused by symptoms (d = 0.61), and with improvements in skills-based mechanisms: mindful emotion awareness (d = 1.44) and reappraisal (d = 1.30). The results suggest that increasing mindful emotion awareness and cognitive reappraisal may be two key therapeutic strategies for reducing NSSI. Transdiagnostic, emotion-focused interventions delivered in time-limited formats can serve as practical yet powerful treatment approaches, especially for lower-risk self-injuring individuals.

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